| NPI | 1710354295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW100824) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker (Licence: CA ASW78642) | |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2021-03-30 |